Federal Reports

This investigation was initiated based on a Hotline allegation that Ms. Meghan Olinger, former AmeriCorps Program Coordinator, Synergy, Education, and Empowerment of West Monroe (SEE), West Monroe, LA, falsely certified education awards for members who had not completed their service hours over the course of her tenure at SEE.

Medicaid and the Children's Health Insurance Program (CHIP) provide health insurance coverage for certain low-income children, yet millions of eligible children are still uninsured. To increase enrollment of eligible children, Congress authorized States to adopt the Express Lane Eligibility (ELE) option, which allows States to expedite and simplify enrollment in Medicaid and CHIP by relying on findings from other agencies' eligibility determinations. Congress will determine whether to reauthorize the ELE option in 2017. We conducted this study in response to a Congressional request that the U.S. Department of Health and Human Services, Office of Inspector General (OIG) examine the benefits and barriers to State use and expansion of ELE. This report is being issued concurrently with two OIG audits that fulfill a Congressional mandate to assess whether State agencies met Federal requirements in making eligibility determinations using ELE and developing eligibility error rates.

The Reports Consolidation Act of 2000 requires the U.S. Department of Education (Department) Office of Inspector General to identify and report annually on the most serious management challenges the Department faces. The Government Performance and Results Modernization Act of 2010 requires the Department to include in its agency performance plan information on its planned actions, including performance goals, indicators, and milestones, to address these challenges. To identify management challenges, we routinely examine past audit, inspection, and investigative work, as well as issued reports where corrective actions have yet to be taken; assess ongoing audit, inspection, and investigative work to identify significant vulnerabilities; and analyze new programs and activities that could post significant challenges because of their breadth and complexity. Last year, we presented five management challenges: improper payments, information technology security, oversight and monitoring, data quality and reporting, and information technology system development and implementation. While the Department remains committed to addressing these areas and has taken or plans action to correct many of their underlying causes, each remains as a management challenge for fiscal year 2017.

States generally determined Medicaid eligibility using the Express Lane Eligibility (ELE) option in accordance with Federal requirements. Under the ELE option, a State Medicaid agency can use findings (e.g., income) from eligibility determinations made by a different agency within the State to facilitate enrollment into Medicaid. From our sample of 157 beneficiaries, States correctly determined eligibility for 133 beneficiaries. We found no errors in 6 of the 10 States reviewed; however, 4 States did not determine eligibility for 17 beneficiaries in accordance with Federal requirements. On the basis of our sample, we estimated that 731,365 beneficiaries were eligible, but 86,672 were potentially ineligible. We also estimated that Federal and State Medicaid payments on behalf of eligible beneficiaries totaled $1.5 billion, and Federal and State Medicaid payments made on behalf of potentially ineligible beneficiaries totaled $284.1 million. We attribute the enrollment of potentially ineligible beneficiaries to State-specific eligibility determination errors.

States generally determined Children's Health Insurance Program (CHIP) eligibility using the Express Lane Eligibility (ELE) option in accordance with Federal requirements. Under the ELE option, a State CHIP agency can use findings (e.g., income) from eligibility determinations made by a different agency within the State to facilitate enrollment into CHIP. From our sample of 120 beneficiaries, States correctly determined eligibility for 110 beneficiaries. We found no eligibility errors in four of the eight States reviewed; however, four States did not determine eligibility for seven beneficiaries in accordance with Federal requirements. On the basis of our sample, we estimated that 148,375 beneficiaries were eligible, but 6,998 were potentially ineligible. We also estimated that Federal and State CHIP payments on behalf of eligible beneficiaries totaled $196.9 million, and Federal and State CHIP payments made on behalf of potentially ineligible beneficiaries totaled $10.6 million. We attribute the enrollment of potentially ineligible beneficiaries to State-specific eligibility determination errors.

The OIG identified strengths within the Generation Construction (GC) Projects organization related to (1) organizational alignment, (2) collaboration within GC departments, (3) management support of employees, and (4) employee engagement. However, we also identified inherent project management risks that, coupled with relationship issues between GC personnel and customer and support organizations, could increase the risk that GC will not be able to effectively meet its mission in the future. Specifically, both GC personnel and customer and support organizations mentioned lack of recognition of how each organization affects the other, lack of knowledge of TVA Standard Programs and Processes, lack of collaboration and communication, and conflicting priorities as issues that affect their relationships.